Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study
Summary: Background: Breast cancer is the second leading cause of death from cancer in women in sub-Saharan Africa, yet there are few well characterised large-scale survival studies with complete follow-up data. We aimed to provide robust survival estimates in women in this setting and apportion th...
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2020-09-01
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Series: | The Lancet Global Health |
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language |
English |
format |
Article |
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DOAJ |
author |
Valerie McCormack, PhD Fiona McKenzie, PhD Milena Foerster, PhD Annelle Zietsman, MD Moses Galukande, MD Charles Adisa, MD Angelica Anele, MD Groesbeck Parham, ProfMD Leeya F Pinder, MD Herbert Cubasch, MD Maureen Joffe, PhD Thomas Beaney, MSc Manuela Quaresma, MSc Kayo Togawa, PhD Behnoush Abedi-Ardekani, MD Benjamin O Anderson, ProfMD Joachim Schüz, PhD Isabel dos-Santos-Silva, ProfPhD |
spellingShingle |
Valerie McCormack, PhD Fiona McKenzie, PhD Milena Foerster, PhD Annelle Zietsman, MD Moses Galukande, MD Charles Adisa, MD Angelica Anele, MD Groesbeck Parham, ProfMD Leeya F Pinder, MD Herbert Cubasch, MD Maureen Joffe, PhD Thomas Beaney, MSc Manuela Quaresma, MSc Kayo Togawa, PhD Behnoush Abedi-Ardekani, MD Benjamin O Anderson, ProfMD Joachim Schüz, PhD Isabel dos-Santos-Silva, ProfPhD Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study The Lancet Global Health |
author_facet |
Valerie McCormack, PhD Fiona McKenzie, PhD Milena Foerster, PhD Annelle Zietsman, MD Moses Galukande, MD Charles Adisa, MD Angelica Anele, MD Groesbeck Parham, ProfMD Leeya F Pinder, MD Herbert Cubasch, MD Maureen Joffe, PhD Thomas Beaney, MSc Manuela Quaresma, MSc Kayo Togawa, PhD Behnoush Abedi-Ardekani, MD Benjamin O Anderson, ProfMD Joachim Schüz, PhD Isabel dos-Santos-Silva, ProfPhD |
author_sort |
Valerie McCormack, PhD |
title |
Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study |
title_short |
Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study |
title_full |
Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study |
title_fullStr |
Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study |
title_full_unstemmed |
Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study |
title_sort |
breast cancer survival and survival gap apportionment in sub-saharan africa (abc-do): a prospective cohort study |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2020-09-01 |
description |
Summary: Background: Breast cancer is the second leading cause of death from cancer in women in sub-Saharan Africa, yet there are few well characterised large-scale survival studies with complete follow-up data. We aimed to provide robust survival estimates in women in this setting and apportion the survival gaps. Methods: The African Breast Cancer-Disparities in Outcomes (ABC-DO) prospective cohort study was done at eight hospitals across five sub-Saharan African countries (Namibia, Nigeria, South Africa, Uganda, and Zambia). We prospectively recruited women (aged ≥18 years) who attended these hospitals with suspected breast cancer. Women were actively followed up by use of a telephone call once every 3 months, and a mobile health application was used to keep a dynamic record of follow-up calls due. We collected detailed sociodemographic, clinical, and treatment data. The primary outcome was 3-year overall survival, analysed by use of flexible proportional mortality models, and we predicted survival under scenarios of modified distributions of risk factors. Findings: Between Sept 8, 2014, and Dec 31, 2017, 2313 women were recruited from these eight hospitals, of whom 85 did not have breast cancer. Of the remaining 2228 women with breast cancer, 58 women with previous treatment or recurrence, and 14 women from small racial groups (white and Asian women in South Africa), were excluded. Of the 2156 women analysed, 1840 (85%) were histologically confirmed, 129 (6%) were cytologically confirmed, and 187 (9%) were clinically confirmed to have breast cancer. 2156 (97%) women were followed up for up to 3 years or up to Jan 1, 2019, whichever was earlier. Up to this date, 879 (41%) of these women had died, 1118 (52%) were alive, and 159 (7%) were censored early. 3-year overall survival was 50% (95% CI 48–53), but we observed variations in 3-year survival between different races in Namibia (from 90% in white women to 56% in Black women) and in South Africa (from 76% in mixed-race women to 59% in Black women), and between different countries (44–47% in Uganda and Zambia vs 36% in Nigeria). 215 (10%) of all women had died within 6 months of diagnosis, but 3-year overall survival remained low in women who survived to this timepoint (58%). Among survival determinants, improvements in early diagnosis and treatment were predicted to contribute to the largest increases in survival, with a combined absolute increase in survival of up to 22% in Nigeria, Zambia, and Uganda, when compared with the contributions of other factors (such as HIV or aggressive subtypes). Interpretation: Large variations in breast cancer survival in sub-Saharan African countries indicate that improvements are possible. At least a third of the projected 416 000 breast cancer deaths that will occur in this region in the next decade could be prevented through achievable downstaging and improvements in treatment. Improving survival in socially disadvantaged women warrants special attention. Funding: Susan G Komen and the International Agency for Research on Cancer. |
url |
http://www.sciencedirect.com/science/article/pii/S2214109X20302618 |
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doaj-5304ca4334f44f16b4f91b209728e6d92020-11-25T03:38:39ZengElsevierThe Lancet Global Health2214-109X2020-09-0189e1203e1212Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort studyValerie McCormack, PhD0Fiona McKenzie, PhD1Milena Foerster, PhD2Annelle Zietsman, MD3Moses Galukande, MD4Charles Adisa, MD5Angelica Anele, MD6Groesbeck Parham, ProfMD7Leeya F Pinder, MD8Herbert Cubasch, MD9Maureen Joffe, PhD10Thomas Beaney, MSc11Manuela Quaresma, MSc12Kayo Togawa, PhD13Behnoush Abedi-Ardekani, MD14Benjamin O Anderson, ProfMD15Joachim Schüz, PhD16Isabel dos-Santos-Silva, ProfPhD17Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France; Correspondence to: Dr Valerie McCormack, Section of Environment and Radiation, International Agency for Research on Cancer, Lyon 69008, FranceSection of Environment and Radiation, International Agency for Research on Cancer, Lyon, FranceSection of Environment and Radiation, International Agency for Research on Cancer, Lyon, FranceAB May Cancer Centre, Windhoek Central Hospital, Windhoek, NamibiaCollege of Health Sciences, Makerere University, Kampala, UgandaDepartment of Surgery, Abia State University Teaching Hospital, Aba, NigeriaBreast Oncology Unit, Federal Medical Centre, Owerri, NigeriaDepartment of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USADepartment of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USADepartment of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Non-Communicable Diseases Research Division, Wits Health Consortium, Johannesburg, South AfricaNon-Communicable Diseases Research Division, University of the Witwatersrand, Johannesburg, South Africa; Noncommunicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa; MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South AfricaDepartment of Primary Care and Public Health, Imperial College London, UKDepartment of Non-Communicable Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UKSection of Environment and Radiation, International Agency for Research on Cancer, Lyon, FranceSection of Genetics, International Agency for Research on Cancer, Lyon, FranceFred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USASection of Environment and Radiation, International Agency for Research on Cancer, Lyon, FranceDepartment of Non-Communicable Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UKSummary: Background: Breast cancer is the second leading cause of death from cancer in women in sub-Saharan Africa, yet there are few well characterised large-scale survival studies with complete follow-up data. We aimed to provide robust survival estimates in women in this setting and apportion the survival gaps. Methods: The African Breast Cancer-Disparities in Outcomes (ABC-DO) prospective cohort study was done at eight hospitals across five sub-Saharan African countries (Namibia, Nigeria, South Africa, Uganda, and Zambia). We prospectively recruited women (aged ≥18 years) who attended these hospitals with suspected breast cancer. Women were actively followed up by use of a telephone call once every 3 months, and a mobile health application was used to keep a dynamic record of follow-up calls due. We collected detailed sociodemographic, clinical, and treatment data. The primary outcome was 3-year overall survival, analysed by use of flexible proportional mortality models, and we predicted survival under scenarios of modified distributions of risk factors. Findings: Between Sept 8, 2014, and Dec 31, 2017, 2313 women were recruited from these eight hospitals, of whom 85 did not have breast cancer. Of the remaining 2228 women with breast cancer, 58 women with previous treatment or recurrence, and 14 women from small racial groups (white and Asian women in South Africa), were excluded. Of the 2156 women analysed, 1840 (85%) were histologically confirmed, 129 (6%) were cytologically confirmed, and 187 (9%) were clinically confirmed to have breast cancer. 2156 (97%) women were followed up for up to 3 years or up to Jan 1, 2019, whichever was earlier. Up to this date, 879 (41%) of these women had died, 1118 (52%) were alive, and 159 (7%) were censored early. 3-year overall survival was 50% (95% CI 48–53), but we observed variations in 3-year survival between different races in Namibia (from 90% in white women to 56% in Black women) and in South Africa (from 76% in mixed-race women to 59% in Black women), and between different countries (44–47% in Uganda and Zambia vs 36% in Nigeria). 215 (10%) of all women had died within 6 months of diagnosis, but 3-year overall survival remained low in women who survived to this timepoint (58%). Among survival determinants, improvements in early diagnosis and treatment were predicted to contribute to the largest increases in survival, with a combined absolute increase in survival of up to 22% in Nigeria, Zambia, and Uganda, when compared with the contributions of other factors (such as HIV or aggressive subtypes). Interpretation: Large variations in breast cancer survival in sub-Saharan African countries indicate that improvements are possible. At least a third of the projected 416 000 breast cancer deaths that will occur in this region in the next decade could be prevented through achievable downstaging and improvements in treatment. Improving survival in socially disadvantaged women warrants special attention. Funding: Susan G Komen and the International Agency for Research on Cancer.http://www.sciencedirect.com/science/article/pii/S2214109X20302618 |